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ANAESTHESIA DATABOOK A Perioperative and Peripartum Manual 3RD EDITION To Chris, without whom the writing of this book would not have been possible. In affectionate memory of the late H Stuart Winsey FRCS, an anaesthetist’s surgeon, and the late Ritabrata Bose (Bosie) FRCA, who valued books. ANAESTHESIA DATABOOK A Perioperative and Peripartum Manual 3RD EDITION Rosemary Mason MB ChB DObst RCOG FRCA Consultant Anaesthetist Swansea NHS Trust Singleton Hospital Swansea SA2 8QA UK © 2001 Greenwich Medical Media Limited 137 Euston Road London NW1 2AA ISBN 1 84110067 6 First published 2001 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organisations outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of Rosemary Mason to be identified as editor of this work has been asserted by her in accordance with the Copyright Designs and Patents Act 1988. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library. Visit our website at: www.greenwich-medical.co.uk Distributed worldwide by Plymbridge Distributors Ltd Typeset by Phoenix Photosetting, Chatham, Kent Printed by Alden Press Ltd, UK SECTION 1 Medical disorders and anaesthetic problems A Achalasia of the oesophagus 3 Achondroplasia 5 Acromegaly 8 Addiction 12 Addison’s disease; adrenocortical insufficiency 14 AIDS; acquired immunodeficiency syndrome 17 Air embolism; see section 2 525 Alcoholism 23 Aldosteronism, Primary 26 Alkaptonuria 26 Alveolar proteinosis, pulmonary 27 Amniotic fluid embolism 29 Amphetamine abuse 29 Amyloidosis 32 Amyotrophic lateral sclerosis 36 Ankylosing spondylitis 36 Antiphospholipid syndrome (Hughes’ syndrome) 40 Aortic regurgitation 43 Aortic stenosis 46 Arnold Chiari (and other Chiari) malformations 49 Arthrogryposis multiplex congenita 51 Asthma 54 Athletic heart syndrome 59 Automatic implantable cardioverter defibrillators 62 Autonomic failure 66 B Becker muscular dystrophy 70 Beckwith-Wiedmann syndrome 71 Budd-Chiari syndrome 73 Buerger’s disease 74 C Carcinoid syndrome 76 Cardiac tamponade 79 Cardiomyopathies; dilated, hypertrophic, restrictive 82 Carnitine palmitoyl transferase deficiency 88 Carotid body tumour 90 Central core disease 91 C1 esterase inhibitor deficiency; acquired 93 Charcot-Marie-Tooth disease (peroneal muscular atrophy) 95 Charge association 96 Cherubism 98 Christmas disease (haemophilia B) 99 Churg-Strauss syndrome 99 Coarctation of the aorta, adult 100 Cocaine abuse 102 Cockayne syndrome 106 Conn’s syndrome (primary aldosteronism) 107 Creutzfeldt-Jakob disease 109 Cri du Chat syndrome 111 Cushing’s syndrome & Cushing’s disease 112 Cystic fibrosis 114 Cystic hygroma (lymphangioma) 119 D Dandy-Walker syndrome 122 Demyelinating diseases 123 Dermatomyositis/polymyositis complex 125 Diabetes insipidus 127 Diabetes mellitus 129 Diffuse idiopathic skeletal hyperostosis 134 Down’s syndrome 136 Drowning and near drowning 139 Duchenne muscular dystrophy 142 v Contents Dystrophica myotonica; and other myotonic syndromes 147 E Eaton-Lambert syndrome (Lambert-Eaton or myasthenic syndrome) 153 Ebstein’s anomaly 155 Eclampsia and severe preeclampsia 156 Ehlers-Danlos syndrome 162 Eisenmenger’s syndrome 166 Emery-Dreifuss muscular dystrophy 169 Epidermolysis bullosa (recessive dystrophic) 170 Epiglottitis 172 Epilepsy 176 F Fabry’s disease 182 Fallot’s tetralogy 183 Familial dysautonomia (Riley-Day syndrome) 186 Familial periodic paralyses 188 Fat embolism syndrome 193 Fibrodysplasia (myositis) ossificans progressiva 196 Fraser syndrome 198 Freeman-Sheldon syndrome 199 Friedreich’s ataxia 200 G Gaucher’s disease 203 Giant axonal neuropathy 204 Gilbert’s disease (idiopathic unconjugated hyperbilirubinaemia) 205 Glomus jugulare tumour 205 Glucagonoma 207 Glucose-6-phosphate dehydrogenase deficiency 208 Glycogen storage diseases 209 Goldenhar’s syndrome 210 Goodpasture’s syndrome 212 Gorham’s syndrome 213 Guillain-Barre syndrome 214 H Haemoglobinopathies (sickle cell disease) 218 Haemophilias A; and haemophilia B 224 Hallervorden-Spatz disease (neuroaxonal dystrophy) 228 Heart block 229 HELLP syndrome 235 Hereditary angioneurotic oedema 238 Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease) 241 Hereditary spherocytosis 245 Hers’ disease (Cori type VI glycogen storage disease) 246 Homocystinuria 247 Hunter’s syndrome; see Hurler’s and mucopolysaccharidoses 249 Huntington’s disease 249 Hurler, Hurler-Schie, Schie, and Hunter’s syndromes 250 Hydatid disease 255 Hypercalcaemia 256 Hyponatraemia 258 Hypothyroidism 262 I Infectious mononucleosis 267 Insulinoma 269 J Jehovah’s Witnesses; management for surgery 272 Juvenile hyaline fibromatosis 277 K Kawasaki disease (mucocutaneous lymph node syndrome) 279 Kearns-Sayre syndrome 280 Klippel-Feil syndrome 282 Klippel-Trenaunay-Weber syndrome 284 L Lambert-Eaton syndrome 287 Laryngeal papillomatosis 287 Latex allergy 290 Lesch-Nyan disease 291 Ludwig’s angina 292 Lysergic acid diethylamide (LSD) abuse 294 M Malignant hyperthermia 296 Marcus-Gunn jaw winking syndrome 303 Marfan syndrome 303 Maroteaux-Lamy syndrome 307 vi Anaesthesia Databook: a perioperative and peripartum manual Mastocytoses 308 McArdle’s syndrome (myophosphorylase deficiency) 311 Mediastinal masses 313 Miller’s syndrome 317 Mitochondrial encephalomyopathies 318 Mitral valve disease 321 Morquio’s syndrome (mucopolysaccharidosis type IV) 328 Motor neurone disease (amyotrophic lateral sclerosis) 330 Moyamoya disease 332 Mucopolysaccharidoses 335 Multiple endocrine neoplasia 336 Multiple system atrophy (Shy-Drager syndrome) 337 Muscular dystrophies 339 Myasthenia gravis 340 Myasthenic syndrome 344 Myeloma, multiple 344 Myoglobinuria 345 Myotubular (centronuclear) myopathy 345 Myxoedema 346 Myxoma, cardiac 346 N Nemaline myopathy 350 Neurofibromatosis (types 1 & 2; von Recklinghausen’s disease) 351 Neurogenic pulmonary oedema 354 Neuroleptic malignant syndrome 354 Noonan’s syndrome 357 O Obesity 360 Obstructive sleep apnoea 363 Opiate addiction 368 Opitz-Frias syndrome 370 Osler-Weber-Rendu syndrome 370 Osteogenesis imperfecta 370 P Pacemakers 375 Paget’s disease 375 Papillomatosis 356 Parkinson’s disease 356 Paroxsysmal nocturnal haemoglobinuria 380 Pemphigus vulgaris and foliaceous 382 Pericardial disease 384 Phaeochromocytoma 384 Phenylketonuria 391 Pierre-Robin syndrome and the Robin sequence 393 Pituitary apoplexy 397 Plasma cholinesterase abnormalities 399 Polycythaemia vera and secondary polycythaemias 402 Pompe’s disease; and adult-onset acid maltase deficiency 405 Porphyria 407 Prader-Willi syndrome 413 Protein C deficiency 415 Protein S deficiency 418 Pulmonary hypertension 419 Pulmonary oedema 423 Q QT interval syndromes, prolonged 433 R Relapsing polychondritis 439 Rett syndrome 441 Rhabdomyolysis 442 Rheumatoid arthritis 447 S Sarcoidosis 452 Schwartz-Jampel syndrome 454 Scleroderma 455 Scoliosis 458 Shy-Drager syndrome 461 Sick sinus syndrome (bradycardia/ tachycardia syndrome) 461 Sipple’s syndrome (MEN 2a) 463 Sjogren’s syndrome 464 Solvent and volatile substance abuse 465 Spinal muscular atrophy 469 Spondyloepiphyseal dysplasia 470 Sturge-Weber syndrome 472 Systemic lupus erythematosus 473 T Takaysu’s arteritis 477 Tetanus 480 Thalassaemia 484 vii Contents Thalidomide-related deformities and other phocomelias 486 Thyrotoxicosis 487 Torsade de pointes (atypical ventricular tachycardia) 491 Tracheobronchomegaly 493 Treacher Collins syndrome 494 Tuberous sclerosis 496 Turner syndrome 497 V Varicella 499 Vipoma 500 Von Gierke’s disease and type 1b glycogenolysis 502 Von Hippel-Lindau disease 504 Von Recklinghausen’s disease 506 Von Willebrand’s disease 506 W Wegener’s granulomatosis 510 Werdnig-Hoffman disease 513 Williams syndrome 513 Wolff-Parkinson-White syndrome 516 Z Zenker’s diverticulum 520 SECTION 2 Emergency conditions arising during anaesthesia or in the immediate perioperative period A Addisonian crisis 523 Air embolism 525 Amniotic fluid embolism 531 Anaphylactoid/anaphylactic reactions to intravenous agents 534 Angioneurotic oedema 542 Aortocaval fistula 543 Arrhythmias 545 B Bronchospasm 548 C Carcinoid syndrome 549 Cardiac tamponade 551 Central anticholinergic syndrome 553 D Glycine absorption syndrome 555 L Latex allergy 555 Local anaesthetic toxicity 557 M Malignant hyperthermia 563 Masseter muscle rigidity 566 Methaemoglobinaemia 569 P Phaeochromocytoma 572 Pituitary apoplexy 576 Pulmonary oedema 577 S Subdural block, accidental 577 Suxamethonium apnoea 580 T Thyrotoxic crisis or storm 581 Torsade de pointes 584 Total spinal anaesthesia, accidental 586 TURP syndrome 588 Appendix 594 viii Anaesthesia Databook: a perioperative and peripartum manual A ACE Angiotensin-converting enzyme AChE Acetylcholinesterase ACLA Anticardiolipin antibody ACTH Adrenocorticotrophic hormone ADH Antidiuretic hormone AF Atrial fibrillation AFE Amniotic fluid embolism AIDS Acquired immune deficiency syndrome AIP Acute intermittent porphyria ALA d-Aminolaevulinic acid (synthase) AMP Adenosine monophosphate APA Antiphospholipid antibody APLS Antiphospholipid antibody syndrome APTT Activated partial thromboplastin time APUD Amine precursor uptake and decarboxylation ARDS Adult respiratory distress syndrome ASD Atrial septal defect AV Atrioventricular A-V Arteriovenous AVP Arginine vasopressin AZT Zidovudine (‘Retrovir’) B BAL Bronchoalveolar lavage BBB Bundle branch block bd Twice per day BG Blood glucose BMR Basal metabolic rate BP Blood pressure C C1 First component of complement C2 Second component of complement C4 Fourth component of complement CABG Coronary artery bypass graft cAMP Cyclical adenosine monophosphate CAPD Continuous ambulatory peritoneal dialysis ChE Cholinesterase C1EI C1 esterase inhibitor CMV Cytomegalic virus CNS Central nervous system CPAP Continuous positive airway pressure CPB Cardiopulmonary bypass CK Creatine kinase CPR Cardiopulmonary resuscitation CRF Corticotrophin-releasing factor CSF Cerebrospinal fluid CT Computerised tomography CVP Central venous pressure CXR Chest X-ray D DDC 3,5-Dicarbethoxy-1,4- dihydrocolidine DDAVP Desmopressin (1-desamino-8-D- arginine vasopressin) DMD Duchenne muscular dystrophy DNA Desoxyribose nucleic acid DVI Digital vascular imaging DVT Deep venous thrombosis E EBV Epstein-Barr virus ECF Extracellular fluid ECG Electrocardiogram ECM External cardiac massage ECMO Extracorporeal membranous oxygenation ix List of abbreviations

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ANAESTHESIA DATABOOK A Perioperative and Peripartum Manual 3RD EDITION To Chris, without whom the writing of this book would not have been possible. In affectionate memory of the late H Stuart Winsey FRCS, an anaesthetist’s surgeon, and the late Ritabrata Bose (Bosie) FRCA, who valued books. ANAESTHESIA DATABOOK A Perioperative and Peripartum Manual 3RD EDITION Rosemary Mason MB ChB DObst RCOG FRCA Consultant Anaesthetist Swansea NHS Trust Singleton Hospital Swansea SA2 8QA UK © 2001 Greenwich Medical Media Limited 137 Euston Road London NW1 2AA ISBN 1 84110067 6 First published 2001 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organisations outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of Rosemary Mason to be identified as editor of this work has been asserted by her in accordance with the Copyright Designs and Patents Act 1988. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library. Visit our website at: www.greenwich-medical.co.uk Distributed worldwide by Plymbridge Distributors Ltd Typeset by Phoenix Photosetting, Chatham, Kent Printed by Alden Press Ltd, UK SECTION 1 Medical disorders and anaesthetic problems A Achalasia of the oesophagus 3 Achondroplasia 5 Acromegaly 8 Addiction 12 Addison’s disease; adrenocortical insufficiency 14 AIDS; acquired immunodeficiency syndrome 17 Air embolism; see section 2 525 Alcoholism 23 Aldosteronism, Primary 26 Alkaptonuria 26 Alveolar proteinosis, pulmonary 27 Amniotic fluid embolism 29 Amphetamine abuse 29 Amyloidosis 32 Amyotrophic lateral sclerosis 36 Ankylosing spondylitis 36 Antiphospholipid syndrome (Hughes’ syndrome) 40 Aortic regurgitation 43 Aortic stenosis 46 Arnold Chiari (and other Chiari) malformations 49 Arthrogryposis multiplex congenita 51 Asthma 54 Athletic heart syndrome 59 Automatic implantable cardioverter defibrillators 62 Autonomic failure 66 B Becker muscular dystrophy 70 Beckwith-Wiedmann syndrome 71 Budd-Chiari syndrome 73 Buerger’s disease 74 C Carcinoid syndrome 76 Cardiac tamponade 79 Cardiomyopathies; dilated, hypertrophic, restrictive 82 Carnitine palmitoyl transferase deficiency 88 Carotid body tumour 90 Central core disease 91 C1 esterase inhibitor deficiency; acquired 93 Charcot-Marie-Tooth disease (peroneal muscular atrophy) 95 Charge association 96 Cherubism 98 Christmas disease (haemophilia B) 99 Churg-Strauss syndrome 99 Coarctation of the aorta, adult 100 Cocaine abuse 102 Cockayne syndrome 106 Conn’s syndrome (primary aldosteronism) 107 Creutzfeldt-Jakob disease 109 Cri du Chat syndrome 111 Cushing’s syndrome & Cushing’s disease 112 Cystic fibrosis 114 Cystic hygroma (lymphangioma) 119 D Dandy-Walker syndrome 122 Demyelinating diseases 123 Dermatomyositis/polymyositis complex 125 Diabetes insipidus 127 Diabetes mellitus 129 Diffuse idiopathic skeletal hyperostosis 134 Down’s syndrome 136 Drowning and near drowning 139 Duchenne muscular dystrophy 142 v Contents Dystrophica myotonica; and other myotonic syndromes 147 E Eaton-Lambert syndrome (Lambert-Eaton or myasthenic syndrome) 153 Ebstein’s anomaly 155 Eclampsia and severe preeclampsia 156 Ehlers-Danlos syndrome 162 Eisenmenger’s syndrome 166 Emery-Dreifuss muscular dystrophy 169 Epidermolysis bullosa (recessive dystrophic) 170 Epiglottitis 172 Epilepsy 176 F Fabry’s disease 182 Fallot’s tetralogy 183 Familial dysautonomia (Riley-Day syndrome) 186 Familial periodic paralyses 188 Fat embolism syndrome 193 Fibrodysplasia (myositis) ossificans progressiva 196 Fraser syndrome 198 Freeman-Sheldon syndrome 199 Friedreich’s ataxia 200 G Gaucher’s disease 203 Giant axonal neuropathy 204 Gilbert’s disease (idiopathic unconjugated hyperbilirubinaemia) 205 Glomus jugulare tumour 205 Glucagonoma 207 Glucose-6-phosphate dehydrogenase deficiency 208 Glycogen storage diseases 209 Goldenhar’s syndrome 210 Goodpasture’s syndrome 212 Gorham’s syndrome 213 Guillain-Barre syndrome 214 H Haemoglobinopathies (sickle cell disease) 218 Haemophilias A; and haemophilia B 224 Hallervorden-Spatz disease (neuroaxonal dystrophy) 228 Heart block 229 HELLP syndrome 235 Hereditary angioneurotic oedema 238 Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease) 241 Hereditary spherocytosis 245 Hers’ disease (Cori type VI glycogen storage disease) 246 Homocystinuria 247 Hunter’s syndrome; see Hurler’s and mucopolysaccharidoses 249 Huntington’s disease 249 Hurler, Hurler-Schie, Schie, and Hunter’s syndromes 250 Hydatid disease 255 Hypercalcaemia 256 Hyponatraemia 258 Hypothyroidism 262 I Infectious mononucleosis 267 Insulinoma 269 J Jehovah’s Witnesses; management for surgery 272 Juvenile hyaline fibromatosis 277 K Kawasaki disease (mucocutaneous lymph node syndrome) 279 Kearns-Sayre syndrome 280 Klippel-Feil syndrome 282 Klippel-Trenaunay-Weber syndrome 284 L Lambert-Eaton syndrome 287 Laryngeal papillomatosis 287 Latex allergy 290 Lesch-Nyan disease 291 Ludwig’s angina 292 Lysergic acid diethylamide (LSD) abuse 294 M Malignant hyperthermia 296 Marcus-Gunn jaw winking syndrome 303 Marfan syndrome 303 Maroteaux-Lamy syndrome 307 vi Anaesthesia Databook: a perioperative and peripartum manual Mastocytoses 308 McArdle’s syndrome (myophosphorylase deficiency) 311 Mediastinal masses 313 Miller’s syndrome 317 Mitochondrial encephalomyopathies 318 Mitral valve disease 321 Morquio’s syndrome (mucopolysaccharidosis type IV) 328 Motor neurone disease (amyotrophic lateral sclerosis) 330 Moyamoya disease 332 Mucopolysaccharidoses 335 Multiple endocrine neoplasia 336 Multiple system atrophy (Shy-Drager syndrome) 337 Muscular dystrophies 339 Myasthenia gravis 340 Myasthenic syndrome 344 Myeloma, multiple 344 Myoglobinuria 345 Myotubular (centronuclear) myopathy 345 Myxoedema 346 Myxoma, cardiac 346 N Nemaline myopathy 350 Neurofibromatosis (types 1 & 2; von Recklinghausen’s disease) 351 Neurogenic pulmonary oedema 354 Neuroleptic malignant syndrome 354 Noonan’s syndrome 357 O Obesity 360 Obstructive sleep apnoea 363 Opiate addiction 368 Opitz-Frias syndrome 370 Osler-Weber-Rendu syndrome 370 Osteogenesis imperfecta 370 P Pacemakers 375 Paget’s disease 375 Papillomatosis 356 Parkinson’s disease 356 Paroxsysmal nocturnal haemoglobinuria 380 Pemphigus vulgaris and foliaceous 382 Pericardial disease 384 Phaeochromocytoma 384 Phenylketonuria 391 Pierre-Robin syndrome and the Robin sequence 393 Pituitary apoplexy 397 Plasma cholinesterase abnormalities 399 Polycythaemia vera and secondary polycythaemias 402 Pompe’s disease; and adult-onset acid maltase deficiency 405 Porphyria 407 Prader-Willi syndrome 413 Protein C deficiency 415 Protein S deficiency 418 Pulmonary hypertension 419 Pulmonary oedema 423 Q QT interval syndromes, prolonged 433 R Relapsing polychondritis 439 Rett syndrome 441 Rhabdomyolysis 442 Rheumatoid arthritis 447 S Sarcoidosis 452 Schwartz-Jampel syndrome 454 Scleroderma 455 Scoliosis 458 Shy-Drager syndrome 461 Sick sinus syndrome (bradycardia/ tachycardia syndrome) 461 Sipple’s syndrome (MEN 2a) 463 Sjogren’s syndrome 464 Solvent and volatile substance abuse 465 Spinal muscular atrophy 469 Spondyloepiphyseal dysplasia 470 Sturge-Weber syndrome 472 Systemic lupus erythematosus 473 T Takaysu’s arteritis 477 Tetanus 480 Thalassaemia 484 vii Contents Thalidomide-related deformities and other phocomelias 486 Thyrotoxicosis 487 Torsade de pointes (atypical ventricular tachycardia) 491 Tracheobronchomegaly 493 Treacher Collins syndrome 494 Tuberous sclerosis 496 Turner syndrome 497 V Varicella 499 Vipoma 500 Von Gierke’s disease and type 1b glycogenolysis 502 Von Hippel-Lindau disease 504 Von Recklinghausen’s disease 506 Von Willebrand’s disease 506 W Wegener’s granulomatosis 510 Werdnig-Hoffman disease 513 Williams syndrome 513 Wolff-Parkinson-White syndrome 516 Z Zenker’s diverticulum 520 SECTION 2 Emergency conditions arising during anaesthesia or in the immediate perioperative period A Addisonian crisis 523 Air embolism 525 Amniotic fluid embolism 531 Anaphylactoid/anaphylactic reactions to intravenous agents 534 Angioneurotic oedema 542 Aortocaval fistula 543 Arrhythmias 545 B Bronchospasm 548 C Carcinoid syndrome 549 Cardiac tamponade 551 Central anticholinergic syndrome 553 D Glycine absorption syndrome 555 L Latex allergy 555 Local anaesthetic toxicity 557 M Malignant hyperthermia 563 Masseter muscle rigidity 566 Methaemoglobinaemia 569 P Phaeochromocytoma 572 Pituitary apoplexy 576 Pulmonary oedema 577 S Subdural block, accidental 577 Suxamethonium apnoea 580 T Thyrotoxic crisis or storm 581 Torsade de pointes 584 Total spinal anaesthesia, accidental 586 TURP syndrome 588 Appendix 594 viii Anaesthesia Databook: a perioperative and peripartum manual A ACE Angiotensin-converting enzyme AChE Acetylcholinesterase ACLA Anticardiolipin antibody ACTH Adrenocorticotrophic hormone ADH Antidiuretic hormone AF Atrial fibrillation AFE Amniotic fluid embolism AIDS Acquired immune deficiency syndrome AIP Acute intermittent porphyria ALA d-Aminolaevulinic acid (synthase) AMP Adenosine monophosphate APA Antiphospholipid antibody APLS Antiphospholipid antibody syndrome APTT Activated partial thromboplastin time APUD Amine precursor uptake and decarboxylation ARDS Adult respiratory distress syndrome ASD Atrial septal defect AV Atrioventricular A-V Arteriovenous AVP Arginine vasopressin AZT Zidovudine (‘Retrovir’) B BAL Bronchoalveolar lavage BBB Bundle branch block bd Twice per day BG Blood glucose BMR Basal metabolic rate BP Blood pressure C C1 First component of complement C2 Second component of complement C4 Fourth component of complement CABG Coronary artery bypass graft cAMP Cyclical adenosine monophosphate CAPD Continuous ambulatory peritoneal dialysis ChE Cholinesterase C1EI C1 esterase inhibitor CMV Cytomegalic virus CNS Central nervous system CPAP Continuous positive airway pressure CPB Cardiopulmonary bypass CK Creatine kinase CPR Cardiopulmonary resuscitation CRF Corticotrophin-releasing factor CSF Cerebrospinal fluid CT Computerised tomography CVP Central venous pressure CXR Chest X-ray D DDC 3,5-Dicarbethoxy-1,4- dihydrocolidine DDAVP Desmopressin (1-desamino-8-D- arginine vasopressin) DMD Duchenne muscular dystrophy DNA Desoxyribose nucleic acid DVI Digital vascular imaging DVT Deep venous thrombosis E EBV Epstein-Barr virus ECF Extracellular fluid ECG Electrocardiogram ECM External cardiac massage ECMO Extracorporeal membranous oxygenation ix List of abbreviations

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